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The Tough Guy prehospital experience: patterns of injury at a major UK endurance event
  1. C Agar1,
  2. L Pickard1,
  3. A Bhangu2
  1. 1
    University of Birmingham, Edgbaston, Birmingham, UK
  2. 2
    St John Ambulance, West Midlands Division, Birmingham, UK
  1. Correspondence to Mr Aneel Bhangu, St John Ambulance, West Midlands Division, 100 Lionel Street, Birmingham B3 1DG, UK; aneelbhangu{at}


Background: Data from mass gathering events help when planning allocation of resources and in setting standards of care. There is currently a lack of data from the UK.

Aim: To determine the frequency of injuries and hospital transfer rates at a large outdoor endurance event.

Methods: 251 patient attendances from four consecutive events over 2 years (two summers two winters; 2006–2007) were analysed.

Results: 1%–2% of contenders required medical help. Hypothermia (n = 84), soft tissue problems (n = 71) and musculoskeletal problems (n = 51) were the most common conditions encountered. 4% of patients required immediate transfer to the hospital. The medical team was able to prevent 31 hospital transfers, which represents a reduction of 78%. 13% of cases specifically required a doctor who was able to prevent more immediate hospital transfers than other care givers. The majority of injuries were classified as minor (n = 228), with the remaining as intermediate (n = 23); there were no life-threatening injuries or deaths. No patient required intravenous fluid. Overall, in winter, more patients were treated when compared with summer (157 vs 94). There were significantly more retirements in winter (69 vs 22, p<0.001), although hospital transfer rates were similar.

Conclusions: Medical teams should plan for casualty rates of 1%–2% of competitors and hospital transfer rates of ∼5% of patients treated. Outdoor events in winter create more casualties than in summer and require greater resources. Trauma and exposure injuries are common; critical illness is uncommon. An adequately equipped and skilled medical team reduces hospital admissions.

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  • Competing interests AB attends Tough Guy as the event doctor, but receives no financial or other reward for doing so.

  • Provenance and Peer review Not commissioned; externally peer reviewed.